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M M <br /> RbPIUBLIC NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br /> SERVICES <br /> 2284006 If waste Is asbestos waste,complete Sections I,11,III and IV <br /> If waste is NOT asbestos waste,camplele Secifons I.[land III <br /> 1. <br /> GENERATOR (Generator completes la-r) 1VE1 <br /> a.Generator's US EPA ID Number b.Manifest Document Number C.Page 1 of <br /> It.Generator's Name and Locallow e.Generalors Mailing Address: S 2015 <br /> Pacific Southwest Irrigation <br /> 8372 S.dacklone ENVIRO WENTAI <br /> f.Phone: Stockton,CA 209346-0791 g,Phone: _ 010711ekr+ <br /> if owner of the generating facility differs from the generator,provide: <br /> h.Owner's Name: 1.Owners Phone No.: <br /> J.Waste Profile# k.Exp.Dale 1.Waste Shipping Name and m.Containers n.Total o.Unit <br /> Description No. Type Quantity WI/Vol <br /> 4204153365 2/1012016 Soil CY <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material Is not a hazardous waste as defined by 40 CFR 261 or any applicable <br /> slaIs law,has been properly described.classified and packaged,and is In proper condition for transportation according to applicable regulations;AND,if this <br /> waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Restrictions.I certify and we <br /> that the waste has <br /> been treated in accordance with the requirements of 40 CFR 268 and is no longer a z ous waste as defined by 40 CFR 281. <br /> Gem ralor Authorized A ent Name Print q.SI nature r. ate <br /> II. TRANSPORTER Generator completes Ila-b and Transporter completes Ilc-e <br /> a.Transporters Name and Address: <br /> Aq <br /> =Phone: .---, .Si naturee.Dat <br /> TION (Generator complete llla-c and De ination Site completes Illd-g <br /> its Address: c.USEPANumbor d.Discrepancy IndicationSpace: <br /> ndfill <br /> 9999 S.Austin Rd. <br /> Manteca,CA 95336 r 2 -902.4 <br /> hereb c rtt Ih?VIhepbJye am aleno ha been ac t d and to It asl of my knowledge the forectoino is Ixe e a <br /> .Name-of Authorized A e rint .SI nature .Dale <br /> IV. ASBESTO (Generator completes IVa-f and Ope at complete IVg-I) <br /> a.Operatoes Name and Address: c.Responsible Agency Name and Address: <br /> b.Phone: d.Phone: <br /> o.Special Handling Instructions and Additional Information: <br /> f. Friable O Non-Friable O Both %Fdable 7.6 Non-Friable <br /> OPERA70R'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the propershlpping name <br /> and are classified,packaged,marked and iabeledfplacarded,and are In all respects in proper condition for transport according to applicable Intent Iton81 and <br /> tonal governmental regulations. <br /> .O Operator's Name and Title(Print) h.Signature <br /> Dols <br /> 'Operator refers to the company which owns,leases,operates,controls,or supervises the facility being demolished or renovated,or the demolition or <br /> renovation operation or both - <br /> REV 01114 :ie'"f 101", Pc"rURN RS-1`11A <br />